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Health Information Systems in Haiti

Electronic medical record (EMR) systems have the capacity to improve clinical decision making and quality of care at site level but can also be leveraged to make data-driven, population-level public health decisions. At the request of the MSPP and the Centers for Disease Control and Prevention Global AIDS Program in Haiti (CDC GAP), I-TECH began developing iSanté electronic medical records system in 2005.

iSanté is used at over 150 hospitals and clinics around Haiti and includes about1.3 million patient records. The system includes patient care summaries, population-level data dashboards, automated program reports, epidemiological monitoring, and indicator reporting, and is linked to computerized lab results. iSanté is integrated with the open-source lab information system OpenELIS, which I-TECH developed in Haiti in partnership with the National Public Health Laboratory.

In 2012, with demands for nation-wide biometric identification, continuity of care, and the ability to send and receive lab results electronically between clinical and referral labs, I-TECH began a review of the current systems. This led to efforts to modernize the system, rebuilding it on an OpenMRS platform. “iSantéPlus” was launched in December 2015 and is currently piloted in three sites in Haiti. It is connected to the Système d’Échange d’Information Sanitaire Haïtien (SEDISH), which is powered by Open Health Information Exchange (OpenHIE). OpenELIS is now interoperable with iSantéPlus using international standards for data transfer and identification.

CHARESS provides technical assistance to health care providers and records officers to use iSanté at point of care. In 2012-13, with impetus from the Haitian Ministry of Health and funders, I-TECH supported some iSanté sites to move toward point-of-care implementation. This involves providers using iSanté during patient visits to enroll patients, review health history, capture clinical assessments and treatment plans, and record drug and laboratory orders. The evaluation, “Report on Best Practices in ‘Point of Care’ Implementation of iSanté and OpenELIS Data Systems,” has expanded the current knowledge of iSanté’s use at point of care, as well as highlighting the benefit of iSanté use to care and treatment.

In partnership with the National HealthQual Committee, CHARESS reinforces data quality and data completeness through system modifications, training, and onsite technical assistance. I-TECH developed national standardized training modules on data management and the iSanté system. View poster, “An Innovative Tool for Supporting Quality of Care and Programme Reporting: The Haiti HIV Electronic Medical Record Project.”  To further this agenda, a National Institutes of Health grant has allowed investigators to explore the potential role of EMR alerts and health care providers in anti-retroviral therapy (ART) adherence counseling in Haitian HIV primary care clinics and conduct a preliminary clinical trial of the enhanced EMR. Results from this study will be available in early 2019.

I-TECH’s goal has always been for iSanté to be fully owned, managed, and maintained in Haiti. There are eight principal areas of EMR management that need to be transitioned: governance (policy framework, decision making structure), software design and development, system administration (servers, helpdesk), implementation (deployment to sites), training, equipment and materials, infrastructure (electricity, internet connectivity), and data use and analysis. For a full discussion of the success factors for implementing and sustaining a mature electronic medical record in a low-resource setting, please see the I-TECH-led publication in Health Policy and Planning. The MSPP is making great strides to ensure the success and ownership of iSanté with recent achievements and progress on sustainability.